DVT complete diagnostic approach resident survival guide

Please find below an algorithm that summarizes the approach to chest pain.

Assess ECG

❑ Presence of ST elevation OR ❑ ST depression in in at least two precordial leads V1-V4 OR ❑ New LBBB

❑ Absence of ST elevation

❑ Rule out life threatening conditions

Does the patient have both of the following: ❑ ST elevation in at least 2 contiguous leads of 2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in leads V2–V3 and/or of 1 mm (0.1mV) in other contiguous chest leads or the limb leads OR ❑ ST depression in at least two precordial leads V1-V4 (suggestive of posterior MI) OR ❑ ST depression in several leads plus ST elevation in lead aVR (suggestive of occlusion of the left main or proximal LAD artery) OR ❑ New LBBB

Does the patient have any of the following: ❑ There is ST elevation in multiple leads that does not follow an anatomic distribution of coronary arteries (ST elevation is diffuse) OR ❑ PR Depression is present OR ❑ PR elevation in lead aVR is present Suspect cardiac tamponade when any of the following findings are present: ❑ Jugular venous distention ❑ Dyspnea ❑ Pulsus paradoxus ❑ Muffled heart sounds ❑ Hypotension

STEMI

Pericarditis

Aortic dissection

Pulmonary embolism

Tension pneumothorax

Esophageal rupture

❑ Activate the cath lab team ❑ Look for supportive signs and symptoms while the cath lab team is mobilized: ❑ The pain is described as a heaviness or crushing sensation ❑ Pain radiating to the left arm ❑ Elbow pain ❑ Shortness of breath or dyspnea ❑ Nausea and vomiting ❑ Diaphoresis ❑ An elevation of the CK MB enzyme ❑ An elevation of the troponin enzyme ❑ An elevation of the myoglobin

Look for supportive signs and symptoms: ❑ Pleuritic pain ❑ Chest pain that is positional ❑ A viral syndrome ❑ Fever ❑ Cough ❑ A pericardial rub ❑ Presence of tamponade

Look for supportive signs and symptoms: ❑ Interscapular pain ❑ Diminution or absence of pulse ❑ Coma ❑ Altered mental status ❑ CVA ❑ Vagal episode ❑ Evidence of ischemia ❑ Splanchnic ischemia ❑ Renal insufficiency ❑ Lower extremity ischemia ❑ Focal neurologic deficits

Look for supportive signs and symptoms: ❑ Shortness of breath ❑ Chest pain ❑ Dyspnea ❑ Anxiety ❑ Pleuritic chest pain

Look for supportive signs and symptoms: ❑ Sudden shortness of breath ❑ Tracheal deviation towards the unaffected side ❑ Absent heart sound on the affected side ❑ Hyperresonance on the affected side ❑ Cyanosis ❑ Penetrating chest wound ❑ Flopping sound ❑ Following a medical procedure ❑ Patient on mechanical ventilation

Look for supportive signs and symptoms: ❑ Vomiting ❑ Hematemesis ❑ Lower chest pain ❑ Cervical subcutaneous emphysema ❑ Overindulgence in alcohol ❑ Overindulgence in food

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Click here for the detailed management

Click here for the detailed management

Click here for the detailed management

If none of the above conditions is found, proceed to the complete diagnostic approach below